Barium poisoning: an uncommon cause of severe hypokalemia

Abstract

Barium poisoning is uncommon. Barium salts are used in a number of industries, including mining, ceramics, plastics, and adhesives and as a green coloring in fireworks. It is also a rodenticide. In poisoning, it blocks passive efflux potassium channels without affecting the Na/K-ATPase pump resulting in an increase in intracellular potassium and extracellular hypokalemia. A 44-year-old man self-presented to hospital six hours following deliberately ingesting 10 g of barium carbonate with suicidal intention. On presentation, he had profuse vomiting with decreased power globally and hyporeflexia in his upper and lower limbs. His ECG was in sinus rhythm with first-degree heart block and diffuse T wave flattening and U wave formation. He had severe hypokalemia with a potassium concentration of 2.4 mmol/L. He was managed supportively with antiemetics and supplemental potassium, receiving 80 mmol of intravenous potassium chloride in total. He was discharged home 24 hours post-ingestion. Soluble barium salts are highly toxic and clinical effects include hypokalemia, flaccid paralysis, cardiac arrest and death. Management of barium toxicity is largely supportive, focusing on the correction of hypokalemia. Oral sulfate salts may prevent absorption through precipitating insoluble barium sulfate in the gastrointestinal tract. Hemodialysis increases elimination and can be considered in severe poisoning.

Relevance of Essential Trace Elements in Nutrition and Drinking Water for Human Health and Autoimmune Disease Risk

“…The mechanism of action of Ba involves blocking K + efflux channels in the cell membrane, with a consequent increase in intracellular K+ levels and extracellular hypokalemia [90].…”

Quantification of Essential Minerals and Heavy Elements in the Scalp Hair of Jordanian Children with Specific Language Impairment

“…Barium carbonate is generally water insoluble, therefore, it is toxicity to humans because of its solubility in the gastrointestinal tract. While the insoluble compounds of Barium are incompetent sources of Ba 2+ ion hence, it is nontoxic to humans [40]. For that, it is important to determine which forms of barium compounds are found and their doses for further future research.…”

Natural Sources of Selenium as Functional Food Products for Chemoprevention

“…It is worth noting the toxic values of barium and radium taken with food is not clearly established; however, Ba toxicity has been reported with ingestions as small as 200 mg Ba/kg/day [ 95 , 96 ].…”